The primary results of female-to-male (FTM) bottom surgery (also known as gender affirmation surgery) include the creation of male-like genitalia, the ability to urinate while standing, and preserved sexual arousal, although penetrative intercourse may not be possible depending on the specific procedures chosen.
Goals and Outcomes of FTM Bottom Surgery
FTM bottom surgery encompasses a range of procedures aimed at creating a more masculine genital appearance and function. The specific results vary depending on the individual's goals and the surgical techniques employed. Common desired outcomes include:
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Masculine Genitalia: Construction of a penis (metoidioplasty or phalloplasty) and scrotum (scrotoplasty).
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Urinary Function: The ability to urinate while standing is a significant goal, usually achieved through urethral lengthening.
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Sexual Function: Preservation of erogenous sensation and the potential for erection are crucial aspects.
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Aesthetic Appearance: Achieving a natural-looking and aesthetically pleasing result is important for many individuals.
Specific Procedures and Their Results
Different surgical options yield different results. Here's a breakdown:
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Metoidioplasty: This procedure involves releasing the clitoris (which enlarges with testosterone therapy) and forming a small penis. Results include:
- A smaller phallus, typically between 4-8cm in length.
- Preserved erogenous sensation.
- The ability to urinate while standing (in many cases).
- Less complex surgery with a shorter recovery time compared to phalloplasty.
- Generally, no vaginal removal (hysterectomy and vaginectomy optional).
- Penetrative sex is typically not possible without additional procedures, such as scrotoplasty with testicular implants and/or a penile implant.
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Phalloplasty: This is a more complex procedure that involves creating a penis using skin grafts from other parts of the body (e.g., forearm, thigh, or back). Results include:
- A larger phallus that more closely resembles a cisgender male penis.
- The ability to urinate while standing (usually after staged procedures).
- Potential for erectile function via a penile implant.
- More extensive surgery with a longer recovery period.
- Greater risk of complications compared to metoidioplasty.
- Hysterectomy and vaginectomy are often performed at the same time or as separate staged procedures.
- Can allow for penetrative sex with a penile implant, although results and success rates vary.
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Scrotoplasty: This procedure involves creating a scrotum using the labia majora. Testicular implants can be placed to enhance the appearance.
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Vaginectomy: Removal of the vagina. This is often performed as part of phalloplasty or as a separate procedure.
Sensory and Sexual Function
- Erogenous Sensation: Both metoidioplasty and phalloplasty aim to preserve erogenous sensation in the phallus. The clitoris, which is rich in nerve endings, is typically incorporated into the new phallus.
- Erections: Erections can be achieved through different means:
- Natural Erection (with Metoidioplasty): The phallus may experience some natural erection due to the existing clitoral tissue.
- Penile Implant (with Phalloplasty): A penile implant is often required to achieve a rigid erection suitable for penetrative intercourse (although success rates and patient satisfaction vary).
Considerations
- Surgical Risks: As with any surgery, FTM bottom surgery carries risks such as infection, bleeding, scarring, and complications related to anesthesia.
- Recovery: Recovery can be lengthy and may involve multiple stages.
- Psychological Well-being: Bottom surgery can significantly improve body image and overall psychological well-being for transgender men.
- Surgeon Expertise: The success of FTM bottom surgery depends heavily on the surgeon's experience and skill.
In conclusion, FTM bottom surgery aims to create functional and aesthetically pleasing male genitalia, allowing for urination while standing and preserving erogenous sensation. While penetrative intercourse may be possible with phalloplasty and a penile implant, it's essential to have realistic expectations and understand the potential risks and benefits of each procedure.
